News 5/4/16

Top News

Pharma services firm Quintiles – which acquired Encore Health Resources in 2014 – will merge with drug data and marketing firm IMS Health, creating a drug data behemoth with 50,000 employees and $7 billion in annual revenue.

Quintiles founder Dennis Gillings, PhD was a biostatistics professor at University of North Carolina at Chapel Hill when he founded Quintiles in 1982, eventually making him a billionaire.  IMS Health is mostly known for selling drug prescribing and dispensing information to drug manufacturers to allow their salespeople to aggressively market their products to physicians.

Reader Comments

From Spiffy Duds: “Re: [vendor name omitted]. Glassdoor reviews say the place is imploding, running scared about Epic threat, losing customers and employees, late on software, new platform released with huge issues. The new president runs a fear-based shop and can’t stick to a strategic decision. The owner knows nothing about healthcare and is an incurable narcissist who believes the company is saving lives and doing things that no one else can do.” Unverified. I’ve omitted the company name since anyone can say anything on Glassdoor, plus Glassdoor now allows full viewing of comments only to those who write a review or submit a salary, of which I’ve done neither.  

From Publius: “Re: Coast Guard and Epic. It’s quite the coincidence that Leidos deleted the Coast Guard’s Epic SAN while working with Cerner on the DoD project.”

HIStalk Announcements and Requests

We funded the DonorsChoose grant request of Mr. S from New Mexico, who asked for electronic circuitry to help Zack, a student in his high school class who has set his sights on obtaining a Harvard math and engineering PhD. Zack reports, “I thank you for empowering me to use electronic circuitry components to create Arduino circuits that I code and assemble. This is most exciting because I can use circuitry components that I previously was unable to access. Thank you for allowing me to do this.”

Also checking in is Ms. W from Arizona, whose preschoolers are learning “sight words” in the 10 minutes per day she has set aside for using them. She reports, “These tools may be small to some, but to my students who do not have the opportunity to have these things, it is a great essential. I can’t wait to continue using these tools for the years to come in my classroom and see the great learning that happens.”

Webinars

May 5 (Thursday) 2:00 ET. “Reducing CAUTI and Improving Early Sepsis Detection Through Clinical Process Measurement.” Sponsored by LogicStream. Presenters: Jen Biltoft, director of quality improvement, SCL Health; Marla Bare, EHR architect, SCL Health. This webinar will describe how SCL Health reduced catheter-associated urinary tract infections by 30 percent in just three months through clinical process measurement. The SCL Health presenters will also share their plans for applying a similar process to the early detection of sepsis.

May 11 (Wednesday) noon ET. “Measuring the Impact of ACA on Providers.” Sponsored by Athenahealth. Presenters: Dan Haley, general counsel, Athenahealth; Josh Gray, VP, AthenaResearch. Athenahealth will share the findings of real-time analysis of its provider network. The presenters will describe how patient financial obligations have changed, how physician reimbursement is trending, the patterns created by increased ACA coverage, and the effect of the latest ACA trends on physician practices.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Healthcare managed services vendor MedData acquires patient engagement software vendor Duet Health.

Behavioral health telemedicine software vendor WeCounsel closes its $3.5 million Series A funding round. The company offers practices unlimited use of its platform for $15 per month.

NIH awards ID Genomics a three-year, $3 million grant to continue development of its 30-minute test that identifies the bacteria causing an infection and matches it against a profile of antibiotic resistance to help doctors choose the right antibiotic.

Cotivity, which sells payment accuracy solutions to payers in healthcare and retail, announces plans to launch an IPO.

Investor Warren Buffett, asked a question about board member diversity at Berkshire Hathaway’s annual meeting, uses Theranos as an example of what not do do when choosing a board:

You know, one organization recently, the one that did the blood samples with small pricks, they’ve got some very big names on their board. Theranos. I mean, the names are great, but we’re not interested in people that want to be on the board because they want to make two or three hundred thousand dollars a year for 10 percent of their time. And we’re not interested in the ones for whom it’s a prestige item and who want to go and check boxes, or that sort of thing.

Imprivata announces Q1 results: revenue up 23 percent, adjusted EPS –$0.21 vs. $-.24, beating analyst expectations for both. 

Announcements and Implementations

England’s West Suffolk NHS Foundation Trust goes live on Cerner.

CommonWell and NATE (the National Association for Trusted Exchange) will join each other’s organization as members.

Government and Politics

A study finds that citizens of states that spend more on social and public health services vs. healthcare services have better outcomes for several chronic and debilitating conditions.

The federal government will require the DoD’s Defense Health Agency to issue IT contracts through the General Services Administration.

Innovation and Research

A study finds that the most profitable hospitals (based strictly on operating income) are for-profit, have higher markups, have regional prestige that allows them to dictate terms to insurers, and are located in states (interestingly enough) with price regulation. The most profitable hospitals in the 2013 data studied were 268-bed Gundersen Lutheran Medical Center (which made $300 million in profit from patient care), Sutter Medical Center, and Stanford Hospital. I checked Gundersen’s federal tax forms, which show 2014 profit of $95 million, down from $312 million in 2013. To its credit, the hospital paid its executives comparatively modestly, with the CEO earning $910K and the CIO $385K.

Half of surveyed teens say they are addicted to their smartphones, with 78 percent of them checking their devices at least hourly and 72 percent believing they must respond immediately to texts and social networking messages. More parents than teens (56 percent) check their devices while driving, while a big chunk of both groups think the other ignores them and plays with their phones when they’re together. 

Technology

Microsoft’s SQL Server 2016 will launch on June 1, with speed and security enhancements, support for the R analytics tool, the ability to query both structured and unstructured data, and the ability to query encrypted data without decrypting it first.

Google donates $250,000 toward Flint, MI’s water problems, of which $150,000 will fund a University of Michigan data project to identify homes with likely high levels of lead. UM will also develop a mobile app and website that will allow residents to visualize data and communicate with the city.

Other

As reported here earlier in quoting Shriners CMIO Richard Paula, MD, the Joint Commission confirms in an emailed newsletter Monday that it has reversed its 2011 policy that prohibited sending orders via text message, effective immediately. Joint Commission says it changed its mind because messaging platforms have improved.

The only rural hospital in Massachusetts — 19-bed, Partners-owned Nantucket Cottage Hospital – may cause all state hospitals to lose $160 million in Medicare funding in the next year after consultants make mistakes in calculating the hospital’s labor costs. The hospital’s high-cost location makes it the state’s most expensive and Medicare sets the labor payments to all other hospitals based on its costs. Some hospitals could lose 10 percent of their Medicare payments due to the mistake.

An interesting article describes Mid-Atlantic Permanente Medical Group’s hepatitis C screening protocol, which has these components:

• An EHR alert recommends to providers that patients born between 1945 and 1965 undergo hepatitis C screening if they haven’t already had it.
• Patients who test positive for the hepatitis C antibody are automatically ordered confirmatory testing.
• An assigned hepatitis C coordinator manages the follow-up activities and educates the patient.
• A liver damage assessment is automatically ordered.
• Patients are connected to physicians to make sure ongoing care occurs.

A Kaiser Health News article concludes that hospitals are not good at coordinating post-discharge care with home health agencies and nursing homes, particularly when it comes to medications. The article notes that none of the $30 billion in HITECH EHR bribes went to nursing homes, rehab facilities, or home care providers. The article failed to note equally sobering problems in coordinating the care of patients with behavioral problems, which have a similar genesis.

The Chinese government will investigate search engine company Baidu following the death of a student who searched online for a treatment for his rare form of cancer. The student claimed that his search turned up a hospital that lied about a high rate of success with an experimental treatment he was given. Before he died, the student accused Baidu of promoting false medical information and called out the hospital for false advertising.

Two large employers who offered a healthcare price transparency tool found that only small percentage of employees used it and healthcare costs actually increased slightly.

A study finds that the price of oncology drugs is steadily and illogically increasing, as drugs whose initial high price was justified by expected narrow usage get more expensive even when new indications are discovered.

Sponsor Updates

• KLAS recognizes Sagacious Consultants (now part of Accenture) as a top-performing Epic consulting firm.
• AdvancedMD releases a new ebook, “Advanced Practice Training: Changing the Game in Financial Reporting.”
• Extension Healthcare releases a video showing how its Engage Mobile solution integrates with AirStrip One live waveforms.
• AirWatch launches the Echo One Podcast.
• Aprima will exhibit at the ACP Internal Medicine Meeting 2016 May 5-7 in Washington, DC.
• KLAS recognizes Nordic’s Epic implementation support and staffing services, also ranking the company for the first time in the IT Advisory segment with a 92.6 score.
• Besler Consulting releases a new podcast, “What Hospitals Should Do Regardless of Who is Elected President.”
• DrFirst’s Rcopia e-prescribing platform wins the Surescripts White Coat of Quality Award for the fourth time.
• CapsuleTech celebrates National Nurses Week May 6-12.
• The Advisory Board Company features Carevive Systems in a presentation during its Oncology Roundtable series May 5-6 in Washington, DC.
• CompuGroup Medical will exhibit at the Rural Health Care Conference May 10-13 in Minneapolis.
• CoverMyMeds will exhibit at the 2016 New England Regional MGMA Conference May 5-6 in Bretton Woods, NH.
• Wellcentive develops a free tool to calculate the cost of delaying the shift from payer volume to value-based care and reimbursement.
• Divurgent will exhibit at the 2016 Texas Regional HIMSS Conference May 12-13 in Houston.
• ECG Management Consultants will present at the MGMA New England Regional Practice Management Conference May 5 in Bretton Woods, NH.
• EClinicalWorks will exhibit at the IMGMA Spring Conference May 5-6 in Indianapolis.
• Healthwise will exhibit at the EClinicalWorks 2016 Health Center Summit May 11-13 in Boston.

Blog Posts

• Provider How-To: Minimizing Gaps in HCC Data Capture (Arcadia Healthcare Solutions)
• Data-Enabled ≠ Data-Driven (Catalyze)
• Protecting Against Ransomware with Layered Security (Impact Advisors)
• Gen Z in HIT (Direct Consulting Associates)
• Revenue Management: Pay Attention to Your No-Show Rates (E-MDs)
• 4 quick tips for your next cybersecurity conversation (The Advisory Board Company)
• The New Architecture of Healthcare Delivery (Part 1) (Extension Healthcare)
• Top 6 Reasons Healthcare Organizations Should Automate the Informed Consent Process (FormFast)
• The Death of an Electronic Note (Galen Healthcare Solutions)
• Tale of Two Systems: Making the Right IT Choice Following a Merger or Acquisition (Hayes Management Consulting)
• Healthcare Cybersecurity: Prevention, Detection, and Training (The HCI Group)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
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Send news or rumors.
Contact us.

Curbside Consult with Dr. Jayne 5/2/16

Since the release of the proposed rule for MACRA, many of my colleagues have been heads down trying to digest the content and figure out how to operationalize the requirements. While some organizations are taking the proposed rule and running with it, others are adopting a “wait and see” approach given the anticipated volume of negative comments from the public. They’re hoping that things will change prior to it becoming final, which is always a possibility given this crazy environment in which we all now operate.

Although CMS talking heads have said MU is dead, it must be zombie-dead. It’s just been reinvented as “Advancing Care Information,” which although more flexible than MU, is still too daunting for many practices. Physicians will not be accountable for cost category measures from claims data as well as being pushed towards further tracking and reporting on PQRS.

There are two tracks for physicians, with CMS expecting that most providers will be in the MIPS track vs. Alternative Payment Models. The numbers I saw estimated were 700,000 vs. 60,000, respectively. Unfortunately, providers will have to decide wither to submit under MIPS before they know whether they qualify for the APM track. Many organizations will be doing a belt and suspenders approach.

Several of my friends that work at vendors are extremely stressed out, realizing that federal requirements will dominate development efforts over the rest of the year. Just when they had breathing room to work on usability and customer-requested enhancements, they’re going to be forced back to the grindstone to crank out code that may or may not be what their customers want or need. Vendors have to walk a fine line between speculating on what will be dropped from the final rule and running full speed to get it all done.

Some vendors will start working on the requirements whether or not they think they’ll be modified. Given the way the last few rulemaking cycles have gone, even if a particular element gets taken out of the final rule, it will likely rear its head in a subsequent rule or in another program, so this might be a wise approach. On the other hand, if the rule is substantially modified, there is a risk of significant wasted development efforts. Once the comment period closes, it will be several months before we have a final rule. My friends with crystal balls tell me we’ll have the final rule in October with it taking effect in January. If that timeline holds, there won’t be much time for vendors to shift gears if the modifications are significant.

In the provider space, there is a tremendous amount of chatter about this being the last straw for small or independent practices. The requirements are daunting, especially for practices who haven’t been at the forefront of payment reform efforts. Just trying to read and understand all the rules and keep track of all the FAQs we’ll undoubtedly see could be a full-time job. As CMS goes, so go the commercial payers, and I expect we’ll see them ratcheting down on physicians as well. I’m still trying to fully absorb how this will affect my own practice given that we opted out of MU and haven’t looked back.

One of my colleagues brought up a good point. Although providers may not be ready to go to a direct model practice or all the way to a concierge / retainer model, providers have been slowly transitioning out of Medicare. It’s tricky for these non-participating providers when they want to continue to care for Medicare beneficiaries. Another option is to opt out of Medicare entirely. The complexity of the choices make it difficult for providers to consider leaving, especially when they consider that commercial payers will have matching requirements of their own that the providers will still have to deal with. The seemingly-onerous nature of the proposed rules might be a catalyst for providers to consider moving to direct models.

When you think about it, direct payment models would go nicely with some of the goals of all these efforts. If the goal is to put the patient at the center of their own care and to engage them, what better way to engage them than with their pocket books? Patients who start to see the true cost of care (rather than being shielded by their co-pays) might start choosing their therapies more wisely. Perhaps the generic drug that’s been around forever but doesn’t have sexy marketing will start looking more attractive.

We’ve experimented with that to some degree with tiered co-pays and that has driven patients to ask about cheaper alternatives. I’ve seen some patients question their hospital-employed physicians when the patients start getting bills from both the provider and the facility through provider-based billing arrangements. A couple of organizations in my region have done away with the practice based on negative community feedback.

Understanding the cost of care may encourage patients and families to make end-of-life choices that are ultimately more compassionate – choosing palliative care or hospice rather than expensive interventions that may not prolong life and may even damage the quality of life. Patients may begin to analyze whether the expensive (and life-altering) cancer treatments that may only extend life a few months are really worth it for them or for their families. Maybe we’ll stop ordering CT scans for things that really could be diagnosed with a good history and physical exam.

Of course, this wouldn’t solve all our problems. The cost of care is still prohibitively high for many treatments. Patients would still need insurance against catastrophic medical bills and we would still need safety net facilities and arrangements for patients who have limited ability to pay.

It also doesn’t address the real origins of healthcare costs. Lifestyle and behavior-related factors are 40 percent of the pie compared to medical care, which is a mere 10 percent. Human biology is 30 percent, with social determinants of health at 15 percent and environmental factors at 5 percent. Although patient engagement may help the lifestyle and behavior-related category, there’s still much more work to be done.

I still have several hundred more pages to get through, but I’m not sure I’ll make it. It’s too depressing.

Have you finished the proposed rule? What do you think? Email me.

Email Dr. Jayne.

Morning Headlines 5/3/16

CHIME Letter to FDA on Interoperable Medical Devices

The College of Healthcare Information Management Executives submits comments to the FDA calling for assurances that medical devices will be interoperable with EHR software.

Not-for-profits dominate top-10 list of hospitals with biggest surpluses

Seven of the 10 hospitals with the largest surplus from patient care services in 2013 were not-for-profits, according to Health Affairs.

Hospital discharge: It’s one of the most dangerous periods for patients

The Wall Street Journal profiles problems that can arise during transitions of care, with a focus on the hospital to home transition.

ResearchKit Unlocks the Power of Real-Time Clinical Research

New studies at Boston Children’s and RWJF highlight the evolving role of Apple’s mobile research technology.
By @JennHIStalk

It’s been just over a year since Apple introduced ResearchKit, an open source framework that enables researchers and developers to design apps for healthcare research. In that time, participation has soared. The platform now boasts 100,000 users who are submitting data to studies sponsored by hospitals and non-profits, including ones focused on asthma, breast cancer, diabetes, heart disease, hepatitis C, melanoma, Parkinson’s, post-partum depression, prostate cancer, and sleep apnea.

Even the NFL Players Association has gotten in on the act, partnering with Harvard University researchers to use ResearchKit in a joint investigation into the long-term effects of football injuries on 3,000 former NFL players.

The platform has also made accommodations for personal genomics via integration with 23andMe’s module. Researchers can enable 23andMe customers to contribute their genetic data to a study or offer genotyping services from the company to study participants. It’s a timely move given the industry’s White House-driven focus on precision medicine and cancer moonshots.

Apple, having realized the escalating potential of its own creation, decided earlier this year to start collecting ResearchKit data for its own internal purposes. Study participants who submit data to the Mole Mapper Study app and Parkinson’s mPower study app now have the option of also submitting that data directly to Apple. The company no doubt plans to use the data to further refine the platform and to impact future iterations of HealthKit and the new CareKit, corresponding apps that help power and further ResearchKit’s capabilities.

Real-World, Real-Time Research

Studies leveraging ResearchKit continue to be introduced, evidence that the platform is well on its way to changing the face of medical research. “It’s the most evolved mobile platform to run studies,” says Paul Tarini, senior program officer at the Robert Wood Johnson Foundation, which has taken an interest in ResearchKit from the beginning. “We’ve been interested in what we call real-world, real-time data for a number of years now, especially what that data can tell us about our health, how it can be used for research, and how it can be used to improve care. ResearchKit was the first formal platform developed to conduct research by taking advantage of the IPhone’s native capabilities to collect real-world, real-time data.”

Tarini and his team began talking about what kinds of apps might be useful within the ResearchKit library not long after its debut. “In discussions with Apple staff and industry experts, we ended up settling on mood and what helps influence mood,” Tarini explains. The result of that decision – RWJF’s Mood Challenge – launched earlier this month.

“We’re hoping the winning app could be used in part or in whole by another study that’s interested in including some aspect of mood or variable in its focus – something that other researchers can pick up, use, and plug in as they build their own apps,” Tarini adds. “We’re also interested in apps that use a mash-up of data, such as data from the phone and other sources, to shed light on mood. In this case, we’re particularly interested in data on social context. What are the graduation rates in your neighborhood? The income rates, family structures, crime rates, weather patterns? How do these influence health, if at all? We’re really focusing on building a culture of health in this country, and social context is certainly a reflection of culture.”

Uncovering the New Normal

Researchers at Boston Children’s Hospital have also been ResearchKit fans from the beginning. “We are proud to be the first academic institution to launch our second ResearchKit app,” says Jared Hawkins, director of informatics and innovation and of the hospital’s digital health accelerator. The hospital launched its C-Tracker app last year to collect data on the effects of hepatitis C and debuted the Feverprints app last month.

“One of the major lessons we learned from C-Tracker was how best to link anonymized data from ResearchKit to our servers at the hospital, securely and at scale,” Hawkins explains. “There are a number of commercial solutions for this, but none of them offered the flexibility that we needed. Fortunately, the C-Tracker team developed open-source software, C3-PRO, to accomplish this, which we have leveraged for Feverprints.”

The Feverprints study and ResearchKit-powered app will help Boston Children’s researchers better understand what a “normal” temperature looks like, how fever patterns can be used effectively to diagnose disease, and how fever-reducing medications affect the course of an illness.

“The standard notion that a normal temperature is 98.6 and a fever is anything above 100.4 is based on questionable research from a few hundred years ago,” says Hawkins. “This study seeks to leverage modern technology, including smartphones and continuous temperature monitoring, to revisit this historical research and collect temperature from tens of thousands of participants to reassess what is normal.”

Form Factor Makes the Difference

The enthusiasm Hawkins has for Feverprints can be largely attributed to ResearchKit’s form factor. “It transforms how we can do clinical research by addressing some of the biggest hurdles we face as researchers – recruitment and long-term engagement,” he explains. “ResearchKit allows us to consent exponentially more users than would be possible traditionally, at minimal cost. These users have the power to enroll themselves, giving them a more direct role in the study and increasing engagement.

“Overall user experience is improved because ResearchKit makes it easier to share health data,” Hawkins adds. “If the user allows it, data from any connected smart thermometer can automatically be loaded from HealthKit. Even if data is entered manually, the whole process takes less than a minute. We hope that the data collected will allow us to identify distinct ‘feverprints’ that may aid clinicians in patient diagnosis in the future. For this, continuous data from a wearable device may prove to be the richest, although temperature data captured at any granularity will be helpful.”

Hawkins add that Feverprints app developers plan to add additional engagement features in the near future that will, for example, allow users to see how their data has specifically helped researchers better understand normal and elevated temperatures, and how they compare to the population as a whole. “We don’t have to wait until the study is over to begin to feed our results back to the user,” he says, “which really drives home the power of participatory real-time research.”

Tarini and his colleagues at RWJF also see immense value in ResearchKit’s data delivery methods. “We like the creativity, the flexibility, and the democratization,” he notes. “More people can enroll in the studies. We also like the fact that the platform is able to turn more results around more frequently to participants.”

Changing the Research Game

While there’s general consensus on ResearchKit’s ability to transform the way clinical studies are conducted, the verdict is still out on it being a bona fide “game changer.” It is, after all, available only to Apple users, which leaves the much larger Android user base without the means to participate. (an Android alternative called ResearchStack became available earlier this month.)

“I wouldn’t call ResearchKit a game-changer,” Tarini says, “because that means we’ve done it. I would say changing. ResearchKit is changing perspective on the importance of returning results to people. It’s producing greater engagement from the people who are participating.”

“We’re also excited about CareKit and the opportunity for more seamless integration of research data with regular care,” he adds. “You can repurpose the data that was collected by the research study and inject it into the processes of care so that a provider can see the data that’s coming in from the study. Previously, that was really hard to do, if not impossible. ResearchKit is changing the relationship between research studies and their participants, and the relationship between the research enterprise and the care delivery enterprise.”

Hawkins is more optimistic about the role ResearchKit has thus far played in the evolution of clinical research. “It’s absolutely a game-changer for health research because it addresses some of the biggest hurdles we face as researchers – recruitment and long-term engagement. We are looking for other projects at the hospital that would benefit from ResearchKit as well as the newly announced CareKit. Apple has built some truly exceptional platforms to enable health research.”

Morning Headlines 5/2/16

Medical Information Technology, Inc. Form 10-Q

Meditech reports its Q1 results: revenue grew 4.3 percent to $117 million vs. $113 million during the same quarter last year, EPS $0.51 vs. $0.53.

Athenahealth Jonathan S. Bush on Q1 2016 Results – Earnings Call Transcript

During its earnings call, Athenahealth CEO Jonathan Bush says that the small-hospital market has experienced a borderline collapse of established technologies, resulting in huge unmet demand that will benefit its expansion into inpatient software.

Revealed: Google AI has access to huge haul of NHS patient data

In the UK, an investigative report finds that Google has been given access to 1.6 million patient records, with visit details going back five years.

Monday Morning Update 5/2/16

Top News

Meditech releases Q1 results: revenue up 4.3 percent, EPS $0.51 vs. $0.53. Product revenue rose 3.2 percent, with 78 percent of that coming from services. The company generated $23.1 million in total cash flow, all of which was paid to shareholders as dividends.

Meditech Director Dan Valente, 85, has resigned as director and was replaced by CFO Barbara Manzolillo.

Reader Comments

From Dixie Chicken: “Re: Epic. Verona, WI will collect taxes based on an Epic campus value of $393 million, but Epic has spent billions on it. If that’s the basis of property taxes, is Verona celebrating when they should feel ripped off?” Verona will close the special tax district it created to get Epic to relocate there from Madison 14 years ago when the company had only 550 employees, cashing in the district’s financial surplus and making Epic’s campus taxable. The property’s value is established at the time the tax district is created, meaning Epic’s massive campus growth (from 550 employees to nearly 10,000) returns only a partial benefit as companies pay only lower, construction-related taxes when they expand.

HIStalk Announcements and Requests

Forty percent of poll respondents think that EHR redesign offers the best hope for reducing the time physicians spend entering data into EHRs, while 25 percent say the capture of non-clinical information is the real problem that should be addressed. Tech MD wonders if those readers who chose EHR redesign or reduced data capture burdens believe the other choice is a lost cause, while Mobile Man says it’s futile to expect EHRs to be redesigned because they are intended to be big filing cabinets. Curious (along with a least one person per poll I run) expresses an unrequited lust for surveys that allow shades-of gray answers, which of course means that he or she must also prefer capturing EHR narrative rather than easily interpreted check-boxes for precisely the same reason  — I would rather force respondents to choose the “best answer” rather than leaving me to wade through 431 free-text comments and abstract their thoughts into a collective opinion.

New poll to your right or here: is the proposed replacement of Meaningful Use with MACRA positive or negative?

Ms. Ahrstrom says the math books we provided to her South Bronx, NY third graders in funding her DonorsChoose grant request have eliminated the boredom using the limited selection of books available in the school’s library, as students can’t wait to finish each book and start the next one.

Also checking in is Ms. B from Minnesota, whose students are still talking about the field trip we provided to the Wildlife Science Center even though it was weeks ago.

Listening: Nico Yaryan, of whom I know basically nothing except he’s a newcomer and I like his music. He sounds like he could make it big. Here’s another of his songs.

Last Week’s Most Interesting News

• HHS issues a Notice of Proposed Rulemaking that spells out details of MACRA, the value-based payment model for providers who accept Medicare. MACRA will replace the Meaningful Use program with less-prescriptive measures called Advancing Care Information.
• Joint Commission announces that it will permit clinicians to send orders via secure messaging, provided that the system they use supports specific message management and EHR integration standards.
• Epic gives its side of the story on why the Coast Guard cancelled its EHR implementation plan.
• NextGen confirms employee layoffs, immediate cessation of development on its NextGen Now cloud-based PM/EHR, and a strong focus on the HealthFusion PM/EHR it acquired for $165 million in January.
• Apple releases the CareKit developer’s framework and announces availability of the first four apps that will use it.
• The FDA rejects the “digital pill” drug application that would have used technology from Proteus Digital Health.
• Nokia acquires consumer health device vendor Withings for $192 million to create Nokia Digital Health.
• CMS releases the minimally redacted warning letter it sent to Theranos last month in which it accused the lab processing company with a lack of knowledge of CLIA standards and diluting finger-stick samples so they could be run on standard Siemens analyzers.
• Verisk Analytics announces that it will sell its Verisk Health services business to Veritas Capital for $820 million.

Webinars

May 5 (Thursday) 2:00 ET. “Reducing CAUTI and Improving Early Sepsis Detection Through Clinical Process Measurement.” Sponsored by LogicStream. Presenters: Jen Biltoft, director of quality improvement, SCL Health; Marla Bare, EHR architect, SCL Health. This webinar will describe how SCL Health reduced catheter-associated urinary tract infections by 30 percent in just three months through clinical process measurement. The SCL Health presenters will also share their plans for applying a similar process to the early detection of sepsis.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

A small reference in Caradigm’s announcement of a new CEO last week says that Microsoft has sold its 50 percent interest in Caradigm the holder of the other 50 percent, GE Healthcare. The company didn’t explain why the change wasn’t otherwise announced.

From the Athenahealth earnings call:

• The company has partnered with Intacct to offer its hospital customers an ERP solution and says it will seek additional partnerships to expand its service capabilities.
• Jonathan Bush said in answering a stock analyst’s question, “In the small-hospital market, there is a borderline collapse of the established technologies, so there is a huge demand … with the exception of Epic and Cerner, most of the HIT companies appear to be just not able to make a go of it.”
• Bush added that Athenahealth won population health management system deals at Dignity and Providence because those health systems trialed products from their existing vendors and found them unacceptable (Dignity is a Cerner shop, while Providence uses Epic).
• Bush said of the company’s efforts to move users of systems from the acquired RazorInsights to those of Athenahealth, “It’s very hard … in order to be that fast, the architecture was more client-centric than network-centric. Every single table — the drug list, the provider directory, the pharmacy supply, the medical supplies — every single one of them is a separate table that only works for each individual customer. That is not the point of Athenahealth … we are taking back those tables, taking back the administration of them and connecting them to great little Web services that connect to national tables that are always current, always correct because they’re maintained by us. That work involves moving the cheese of people that have worked very hard on their tables for years. So, it’s painful.”
• Bush replied to an analyst’s question about an unnamed competitor moving to a cloud-based product, “You need to double-check on the idea that anybody that you’re thinking about is cloud-based. That somebody will host your data center and run backups does not make them cloud-based. I just described the agony we’re going through centralizing the remaining tables that are being maintained by clients. These are companies where 100 percent of tables are maintained by clients. This is just rental software and 99 percent of the code is running on the servers in the client side. So let’s be clear — those guys are not cloud-based.”
• When asked about the credit-worthiness of hospital prospects, Bush said, “We used to joke in selling to doctors in the early days that we restrict our sales team to doctors that have a pulse. That was an interesting comment at the time because a lot of the doctors’ pulses that we originally signed were quite thready at best … not only are the HIT companies dying, but a lot of the hospitals are dying … . You have very, very low bed occupancy in this segment, a need to dramatically change strategy from kind of end provider of inpatient and acute care to front-end of the larger health system for the ill … if you took the imaging margins out of every hospital right now, more than half the hospitals in the country would close. Some of the best names in healthcare with the best institutions in healthcare have the majority of their profits coming just from an anomaly where the cost of the imaging equipment is going down because of digital equipment faster than Medicare can figure it out and chase them down.”
• Bush explained the company’s More Disruption Please program as, “It’s too bad that Epic and Cerner and Meditech and all these guys can’t build open enough platforms, because we don’t really want to do Athena dietary management systems. But if it doesn’t come out of MDP and if Epic and Cerner and Meditech don’t open up their API so that they could be used by responsible developers, what can you do?“
• Bush replied when asked about adding billing capabilities to the former RazorInsights product, “The front desk for the hospital is the front desk for AthenaNet. It’s the same front desk, same work flow, same insurance capture, same portal registration … one of the big arbitrage opportunities for AthenaOne for the inpatient is, we get all the doctors around the hospital. We don’t have to register them when they show up at the hospital. We already know what their deductible utilization is, we already know their eligibility, we know their medical records, et cetera, et cetera  … there has been a product we’ve been dying to release for years, for a decade, called AthenaController, which basically takes on the same approach to the cost cycle as we have to the revenue cycle. We are now pregnant with that baby. We have to do it.”

People

Ryan Nellis (Optum) joins Stanson Health as SVP of sales and marketing.

Announcements and Implementations

Clinical Architecture launches its SIFT Services product line, which uses natural language processing to extract coded data from free-text documents for specific data targets. The company offers a free trial of the first offering, SIFT for Meds. 

Nordic hires its 600th consultant.

Government and Politics

Political differences aside, President Obama might offer Ronald Reagan a challenge for the title of funniest American president ever. Above is the video, “Couch Commander,” released by the White House and presented at the White House Correspondents’ Association Dinner. The Obamacare references at 1:33 are interesting.

Privacy and Security

A science magazine analysis finds that the agreement between the UK’s NHS and Google’s artificial intelligence company DeepMind gives the company full electronic information on 1.6 million patients treated annually by three hospitals of Royal Free NHS Trust. Google says it needs complete information on all patients because NHS can’t provide a subset just for the kidney patients who will be monitored by Google’s Streams system. The agreement also calls for Google to develop a clinical decision support and surveillance system called Patient Rescue that will use real-time data streams from the hospitals. Critics are not only worried about Google keeping the patient information secure, but also that Google is the only company with access to the data.

The American Dental Association notifies subscribers to its Dental Procedure Codes that some of its thumb drive updates contain malware. The ADA speculates that one of the duplicating machines used by ADA’s China-based manufacturer were infected with data from a previous customer, meaning that only the drives produced by that specific machine contain malware.

Other

Here’s a nice quote from Farzad Mostashari, MD in responding to a tweet saying that non-profit Minnesota HIMOs (like most health systems everywhere) insist that what’s left when income exceeds expenses is a “surplus” rather than a “profit,.” although they seem to love the word “loss” when things aren’t so rosy. Perhaps Farzad can weigh in on “payment” vs. “reimbursement” and “invested” vs. “spent.”

Dear Health Data Management, please spell company names correctly, not like the actual word is spelled. Thank you.  While I’m quibbling journalistically, I would to ask newspapers to stop saying that someone “checked himself in” to a hospital since that just doesn’t happen.

Here’s the next HIS Vendor Review from Vince and Susan, which this time looks at high-end vendors.

Sponsor Updates

• T-System will exhibit at the CHIMA Annual Meeting May 5-6 in Denver.
• The local news interviews TeleTracking President Michael Gallup about the company’s sponsorship of the Walk MS Pittsburgh 2016 event.
• Fortune profiles Validic.
• Vital Images will exhibit at the McKesson User Group May 2-4 in Atlantic City, NJ.
• Huron Consulting Group will exhibit at the MAGI Clinical Research Conference 2016 East May 1-4 in Boston.
• Wellsoft will exhibit at Emergency Medicine Update 2016 May 3-5 in Toronto.
• ZeOmega offers the Jiva Consultant Certification Program.
• PatientPay extends the $10,000 healthcare billing challenge.
• Streamline Health will exhibit at the 2016 DCHIMA/MDHIMA Annual Meeting May 6 in Hanover, MD.

  Blog Posts

Blog Posts

• Doctor’s Orders: The Joint Commission allows texting. (Voalte)
• Healthcare’s Moving Into the 21st Century, but Many Users are Holding on to 20th Century-Style Expectations (West Corp.)
• Why Partner with an RCM Clearinghouse? (ZirMed)
• The Future of Enterprise Mobility is Here: What’s Your Strategy? (PatientSafe Solutions)
• Lessons From Our Recent Provider Survey (Patientco)
• A Prescription for Physician Applications (PatientKeeper)
• Preventing readmissions through enhanced care team collaboration (PerfectServe)
• Mary Greeley Medical Center Weighs In (PeriGen)
• Predictions of Apple Q2 Earnings from Medical Charge Capture and Secure Messaging Users (PMD)
• Biosimilar Legislative Trend Means Big Changes for EHRs (Point-of-Care Partners)
• Providers, EHR Vendors Weigh-In on the Importance of Electronic Prior Authorization (Surescripts)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates.
Send news or rumors.
Contact us.

Morning Headlines 4/29/16

Medicare’s new plan for paying doctors: 10 key takeaways

The Advisory Board Company recap’s yesterday’s MIPS and APM incentive proposed rule.

Leidos Holdings, Inc. Reports First Quarter Fiscal Year 2016 Results

Leidos reports Q1 results: revenue grew five percent to $1.31 billion vs. $1.25 billion in the same quarter last year, adjusted EPS $0.72 vs. $0.67. Executives announced that

Athenahealth, Inc. Q1 Profit Rises 47%

Athenahealth reports Q1 results: revenue climbed 24 percent to $256 million vs. 206 million in the same quarter last year, EPS $0.34 vs. $0.24, beating expectations on both.

FDA rejects antipyschotic drug/device combo

The FDA has rejected Proteus Digital Health’s request to embed smart sensors designed to track medication compliance into Otsuka’s antipsychotic medication Abilify.

News 4/29/16

Top News

HHS issues a Notice of Proposed Rulemaking for the long-awaited Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which will replace the Meaningful Use program in moving clinicians to payment based on value starting in 2017. The Merit-Based Incentive Payment System (MIPS) sets Medicare payments based on quality, use of technology, clinical practice improvement, and cost. Physicians participating in alternate payment models such as CPC+ and the Next-Generation ACO will be eligible to receive bonuses without participating in MIPS.

A CMS blog entry from CMS Administrator Andy Slavitt and National Coordinator Karen DeSalvo says Meaningful Use boosted EHR usage, but adds, “We remain a long way from fully realizing the potential of these important tools to improve care and health.” HHS says incorporating Meaningful Use in the MIPS program in a program called Advancing Care Information will “make it more patient-centric, practice-driven, and focused on connectivity.”

Slavitt and DeSalvo’s article says Advancing Care Information will:

• Simplify physician reporting by eliminated all-or-nothing measures.
• Provide flexibility for doctors to choose the most applicable measures.
• Emphasize interoperability and the right for patients to access their own information through APIs.
• Reduce the number of measures from 18 to 11.
• Exempt doctors from reporting if EHR technology isn’t applicable to their practice.

The article sheds light on the technology focus going forward:

These improvements should increase providers’ ability to use technology in ways that are more relevant to their needs and the needs of their patients. Previously established requirements for APIs in the newly certified technology will open up the physician desktop to allow apps, analytic tools, and medical devices to plug and play. Through this new direction, we look forward to developers and entrepreneurs taking the opportunity to design around the everyday needs of users, rather than designing a one-size-fits-all approach. Already, developers that provide over 90 percent of electronic health records used by U.S. hospitals have made public commitments to make it easier for individuals to access their own data; not block information; and speak the same language. CMS and ONC will continue to use our authorities to eliminate barriers to interoperability.

The proposed HHS changes would affect only Medicare payments to practices. Nothing will change for hospitals and Medicaid program participants.

The full text of the 962-page proposed legislation is here. The Advisory Board Company posts a good summary.

Here’s a new three-minute HHS video for consumers that describes delivery system reform.

Reader Comments

From Richard Paula: “Re: texting of orders. The May 2016 Joint Commission Perspectives will contain a revised statement on texting orders, ending the ban enacted in 2011. It reinforces the fact that texting can be an expedient method of patient care. The secure texting platform must have:

• A secure sign-on process
• Encrypted messaging
• Delivery and read receipts
• Date and time stamp
• Customized message retention time frames
• Specified contact list for individuals authorized to receive and record orders

It requires text orders to be complete, dated. timed, confirmed, authenticated, and documented in the medical record.” Rich is CMIO of Shriners Hospitals for Children. This is a pretty big deal as companies whose messaging product can’t integrate with EHRs to complete the order loop now find themselves at a significant competitive disadvantage.

From Marshal: “Re: Meditech. Delta Regional in MS has signed to replace Cerner with Meditech. Salem Regional Medical Center in OH has signed with Meditech to replace their McKesson Horizon system. Cerner was the other finalist in that bid.” Unverified. 

From Graham: “Re: Coast Guard EHR. I saw that Politico just replayed your coverage from last October. The Coast Guard won’t say if a particular provider’s software caused the issues. What’s your take on where accountability resides? Sounds like mismanagement at a project level by USCG themselves, but Epic paying back $2.2 million on a $14 million award isn’t immaterial, either. It gets even fuzzier with the InterSystems component coming in later and then Leidos / Apprio / Lockheed.” The Coast Guard cited unstated problems with the implementation, seemingly blaming itself for a lack of consistent workflows and ongoing scope expansion, while outsiders speculate that it handled the product selection poorly and that Epic and Leidos may have bid too low to  meet the Coast Guard’s expectations.

Meanwhile, Epic uncharacteristically posts its side of the Coast Guard story, saying its software was originally ready for go-live in 2011, but Coast Guard changes such as hardware procurement delays, vendor changes, data center changes, and a government accounting investigation of the Coast Guard’s method of payment threw the schedule off. The Coast Guard’s storage area network was also lost twice, once from corruption and once after someone from Leidos deleted it. Epic says the go-live was rescheduled for October 2015 and was on track until the Coast Guard cancelled it the month before for unstated reasons. Epic says it was paid in full and the Coast Guard did not ask for a refund.

HIStalk Announcements and Requests

I’m interested to learn what sort of EHR prototype the VA is creating in exploring the idea of replacing VistA with what sounds like another self-developed product. Let me know if you can provide information, on or off the record.

The vast majority of 514 poll respondents (92 percent overall, including 90 percent of the females and 93 percent of the males) think it’s a bad idea for HIMSS to publish a separate website and newsletter for women in healthcare IT. Sandra says the goal is to be separate but equal rather than separate but separate, while NoHorseInThisRace says its a disservice for HIMSS to be “peddling its clickbait drivel” specifically at women. Lisa says she might take an occasional look but since the issues and concerns are the same for everyone, the choice of content the site will promote will be interesting. Long Disappointed by HIMSS adds that, “The comment made on HIStalk is appropriate – look no further than the board.” The women’s interest stories so far is lame – it’s anything related to Karen DeSalvo, third-party stories on gender pay gap, and mentions of people who have been promoted who happen to also be female.

Ms. Anderson’s Arizona fourth graders, especially her special education students, have used the electricity and magnetism kits we provided in funding her DonorsChoose project to complete her standards-based assignments while having fun.

Also checking in is Ms. Isaacs, whose Indiana second graders are using the 16 sets of headphones we provided to participate in an online literacy program, which she saves “gives our class the opportunity to focus on what we are learning rather than the other students around us.”

This week on HIStalk Practice: Thirty-six practices sign up for CancerLinq’s oncology analytics. Raleigh Orthopaedic Clinic settles with OCR to the tune of $750,000. AMA partners with IDEA Labs to support student entrepreneurship in healthcare IT. The American Telemedicine Association aims to broaden the Rural Health Care Connectivity Act. Reliance ACO COO Gene Farber highlights the role of CCM in coordinated care. UniVision gets into telemedicine. Vice President Joe Biden set to spice up Health Datapalooza. CDW’s Jonathan Karl offers advice on how to promote positive outcomes with communication and technology.

Webinars

May 5 (Thursday) 2:00 ET. “Reducing CAUTI and Improving Early Sepsis Detection Through Clinical Process Measurement.” Sponsored by LogicStream. Presenters: Jen Biltoft, director of quality improvement, SCL Health; Marla Bare, EHR architect, SCL Health. This webinar will describe how SCL Health reduced catheter-associated urinary tract infections by 30 percent in just three months through clinical process measurement. The SCL Health presenters will also share their plans for applying a similar process to the early detection of sepsis.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

A RBC Capital Markets analysis says Quality Systems / NextGen issued investor updates Wednesday indicating that it will focus on streamlining management, building up the business of the HealthFusion PM/EHR it acquired in January for $165 million, and cutting costs furthers. Analyst Dave Frances expresses skepticism on the downbeat business changes announcement given a shrinking market share in QSI’s core business, adding that, “We remain unconvinced that HealthFusion and Mirth are the answer.” Quality Systems says it will stop development on its NextGen Now product immediately, taking a $32 million charge and confirming that it will reduce headcount by 150 as I previously reported from reader rumor reports. The cloud-based NextGen Now PM/EHR was announced in November 2014 and was supposed to be launched in 2015.

A New York Times op-ed piece says Theranos wasn’t a product of Silicon Valley hype – the company pitched to top life sciences venture capital firms whose doctorate-heavy investment teams were put off by Theranos trying to appear cool while keeping the technical details intentionally vague. Those VCs also noted that Theranos hadn’t published in peer-reviewed journals and that the company’s board was made up of mostly old politicians with zero healthcare experience. The company’s investors were non-Silicon Valley types who were apparently less discerning.

Leidos announces Q1 results: revenue up 5 percent, adjusted EPS $0.72 vs. $0.67. Chairman and CEO Roger Krone says in the earnings call it’s on track to bring the DoD’s MHS Genesis Cerner project live at two facilities in the Northwest by the end of the year, but Leidos will also continue making money supporting the old system for another 8-10 years until the Cerner rollout is finished.

Athenahealth announces Q1 results: revenue up 24 percent, EPS $0.34 vs. $0.24, beating analyst expectations for both. ATHN shares are up 13.3 percent on the year.

Spok reports Q1 results: revenue down 6 percent, EPS $0.17 vs. $0.18. The SPOK share price is down 12.9 percent compared to a year ago.

Vocera announces Q1 results: revenue up 12 percent, EPS – $0.14 vs. –$0.17, beating analyst expectations for both. VCRA shares are up 7.8 percent in the past year.

Sales

MedStar Health (MD) chooses provider data management and scheduling software from Kyruus.

UK Healthcare selects Voalte for caregiver secure messaging.

People

Medfusion hires John Juzaitis (ZirMed) as chief revenue officer and Michelle Murray (EDM Americas) as VP of marketing.

Brigham and Women’s Health Care (MA) promotes Adam Landman, MD to CIO.

Caradigm promotes Neal Singh to CEO. He replaces founder Michael Simpson, who has left the company.

Anita Pramoda (Owned Outcomes and former Epic CFO) joins the board of Health Catalyst, replacing EVP/Co-Founder Steve Barlow, who remains on the executive team.

Announcements and Implementations

The first four apps that use Apple’s CareKit developer’s framework are released to the Apple Store as the open source CareKit itself is also released to GitHub. The apps are Glow Nurture (fertility tracking), Glow Baby (maternity), One Drop (diabetes monitoring), and Start (depression medication tracking).

Other

Here’s a cute “Take Our Daughters and Sons to Work Day” photo from Karen DeSalvo’s office from @Commanda4aCure.

The FDA rejects the application for a drug-device combination, or so-called “digital pill,” to monitor drug adherence. FDA had already cleared the use of Proteus Digital Health’s technology in existing drugs, but wants to see more data before allowing Otsuka Pharmaceutical manufacture it as part of its Abilify antipsychotic medication. Proteus has raised $334 million in 10 rounds of funding, adding $50 million earlier this month.

A man sues Snapchat and the 18-year-old driver who rear-ended his car at 107 miles per hour while taking a selfie, leaving him with brain damage. The teen admitted that she was speeding while posting to earn a Snapchat “speed filter” trophy icon for recording her speed with her photo. After the crash, the teen took a photo of her bloodied face and labeled it “lucky to be alive.” Snapchat says it gives users a warning not to use its speed filter option while driving.

This TV screen grab will resonate with everyone annoyed by poorly timed Windows 10 update nagware messages.

Sponsor Updates

• Employees of Impact Advisors attending the company’s annual meeting in Orlando delivered 150 teddy bears to patients at Florida Hospital for Children.
• Florida Hospital (FL) reports decreased mortality and a $72.5 million increase in appropriate reimbursement after rolling out Nuance’s Clinical Documentation Improvement embedded, with the next step being to embed Nuance Clintegrity CDI within Cerner Millennium.
• Bernoulli will exhibit at the at the American Association of Critical-Care Nurses’ 2016 National Teaching Institute & Critical Care Exposition (NTI), May 16-19 in New Orleans.
• Intelligent Medical Objects will exhibit at the IHealth 2016 Clinical Informatics Conference May 4-7 in Minneapolis.
• MedData will exhibit at the Louisiana Chapter HFMA Annual Institute May 1-3 in Lafayette.
• Orchestrate Healthcare will help Pertexa integrate its Radekal physician productivity tool for hospital use. The tablet-based product expedites the clinical encounter, reducing visit time by up to 30 percent.

Blog posts

• Improve your revenue cycle: Make your providers more accessible [podcast] (Nordic)
• Information Sharing is Caring – If You Do It Right (ID Experts)
• Local SEO & Listings Management are Essential in Healthcare Marketing (Influence Health)
• Our Top 10 Favorite Moments from the InstaMed 2016 User Conference (InstaMed)
• Have We Created Connected Value for the Healthcare Community? (InterSystems)
• Discover the 5 Hidden Costs of Data Security and Compliance (Part 1) (Liaison Technologies)
• Health Data Interoperability or Bust (LifeImage)
• Introducing the Vyne Brand (Vyne, formerly MEA I NEA)
• The Role of Continuity in the Acute Care Setting (MedAptus)
• 6 tips for rocking Nordic’s best* maxim: Listen. (Nordic)
• By the Numbers: The Secure Text Messaging Market (Spok)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates.
Send news or rumors.
Contact us.

EPtalk by Dr. Jayne 4/28/16

My phone started going into shock Wednesday afternoon with the release of the 962-page proposed rule for the Medicare Merit-Based Incentive Program (MIPS) and Alternative Payment Model (APM) Incentive under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models.

Vendors and providers alike have been eagerly awaiting the details hinted at by MACRA when it was passed last year. Providers were hopeful about the potential for consolidation of the alphabet soup of PQRS, VBM, and Meaningful Use.

It starts with the customary glossary of acronyms, which numbers nearly three pages. It also includes an overview of current reporting programs and regulations. For people who haven’t been immersed in the federal regulatory stew for the better part of a decade, it must seem like so much gibberish.

The provisions regarding the “Sunsetting of Current Payment Adjustment Programs” starts on page 35. A section on “information blocking” caught my eye on page 41 despite the fact that information blocking as defined by Congress seems much more theoretical than actual for most of the organizations I’ve encountered. Page 44 brings nearly three pages of new terms which require definitions. I gave it my best effort, but I couldn’t make it more than 100 pages. For those with longer attention spans, the comment period is open through June 27.

Registration is open for the AMIA 2016 Symposium, to be held at the Chicago Hilton. The Student Design Challenge, now in its fourth year, will focus on engaging providers and patients in precision medicine. Proposals are due by June 30 with notifications to authors on August 15.

For those who can’t wait until the fall for your next informatics meeting fix, the 2016 ONC Annual Meeting will be held May 31 through June 2, with the last day being focused on consumers. Agenda details are still forthcoming, so I’m not quite ready to commit just yet.

I enjoy attending conferences and connecting with colleagues across the country to discuss best practices and innovative ways to move healthcare forward. In my own world, though, I’d settle for healthcare that met the bare minimum.

I’ve been in a downward spiral, with several negative ophthalmology experiences over the last several years, but this week’s visit took the cake. My physician (the third in that I’ve seen in the practice) recently went on an indefinite medical leave, so I was called to reschedule with one of her partners. I always book the first appointment of the day so that I can be on time for the rest of my schedule. Unfortunately, my new physician was stuck in traffic.

He phoned the office five minutes after my appointment started. The practice has an open front desk, so I could hear the receptionist talking with him. I was dumbfounded when she told him that he didn’t have any patients in the office yet, especially since I had been checked in with my co-pay posted for 15 minutes.

About five minutes after she finished the call with him, she called me up to tell me what was going on. After another 10 minutes, a technician took me back to an exam room to get things started so I’d be ready when he arrived. She asked my reason for visit, and when I told her, she promptly asked why I was seeing Dr. X because he doesn’t treat patients with my chief complaint.

I reminded her that the practice is the one that scheduled me for the physician and should have known from my original appointment reason in the scheduling system what I was coming in for and that it was going to be a problem. I then got to hear through the open doorway as the staff called the physician in his car to ask what to do about me.

He agreed to see me, which I thought was odd if it was outside his area of expertise, but I decided to keep the appointment so I could get my prescription, which had expired due to the rescheduling with my previous physician’s departure.

When he arrived, he was apologetic, and told me “How great that was that the office was able to get in touch with you and have you come in later so you didn’t have to wait for me?” That’s certainly a creatively editorialized version of what happened, but by this point, I wasn’t surprised by anything. He performed only part of a typical exam, pronouncing my eyes “healthy” and then sending me to the front desk with a paper superbill that included charges for services he didn’t actually render.

I hadn’t mentioned that I was a physician. I wonder if he would have performed the way he did had he known that I was? It shouldn’t matter, though – the things that happened during this visit shouldn’t have happened to any patient anywhere. The fact that this occurred at a major academic medical center was particularly distasteful. Although the office manager was appropriately horrified, I’m still waiting for a call back from the department chair.

I have no idea whether his behavior was a result of his being late or generally poor practice. I’m waiting for a copy of my visit note to see what he documented in comparison to what he actually did and what he attempted to bill. In the meantime, I have an appointment across town to see another physician.

If we can’t even get basic medicine right, what hope is there? Email me.

Email Dr. Jayne.

Morning Headlines 4/28/16

Moving Toward Improved Care Through Information

CMS publishes details on how physicians will be paid under MACRA’s Merit-based Incentive Payment System, including new standards for using EHRs in a program called Advancing Care Information.

Christie says New York joins New Jersey drug monitor program

New York and New Jersey officials agree to start sharing information from each state’s prescription drug monitoring program.

Adam Landman, MD, MS, MIS, MHS, Named Chief Information Officer at Brigham and Women’s Health Care

Adam Landman, MD is named CIO of Brigham and Women’s Hospital. Landman had been serving as the hospital’s CMIO for Health Information Innovation and Integration.

2016 Data Breach Investigation Report

Verizon publishes its annual report on data breaches, finding that insider misuse, miscellaneous human errors, and lost or stolen property generated for the most beaches in healthcare in 2015.

Readers Write: Healthcare Consumerism

Healthcare Consumerism
By Helen Figge

Everyone has at least one healthcare catastrophe to share. Mine is simple. My mother died of a mischievous breast cancer that disintegrated her bones, but only after it was missed “buried” in a pile of papers several years before.

One sentence tells all in a scribbled office note: “current testing could not rule out malignancy — suggest follow up.” The problem was that no one ever informed my mother. We only found incidentally upon her demise. The electronic health record with data exchange capabilities could have given a temporary reprieve.

Technology, however, did enter her life before her untimely death. Mobile technology in her final days delivered every hospital amenity into her home, supporting her last wish “to die in the same room I was born in,”which was 64 years earlier. Innovative healthcare technologies do indeed play a role and can satisfy the healthcare consumer, but certainly in this instance, arrived too late to be her savior.

Technologies are gearing more towards self-monitoring, self-direction and consumer empowerment. At least 52 percent of smartphone users directly gather their health-related information along with indications of how poorly or well one is living life. Healthcare technologies are creating an opportunity for the consumer’s total control of his/her own health destiny. But is this proactive or counter-productive? Is it a sustainable model for healthcare awareness?

Companies are offering technologies that provide the consumer access to laboratory results via apps that are private, secure, and fast, able to be viewed 24/7. However, in some instances, inaccurate results create self-doubt to the end user and clinicians. As the next chapters of technology dissemination evolve, vendors need to better understand what the end user is really looking for in order to support and sustain this new wave of healthcare consumerism.

Chronic diseases are often manageable and sometimes even preventable, yet the healthcare delivery system seems to do better at optimizing managing rather than preventing diseases. In order to turn the pendulum around in healthcare delivery and disease prevention and finally make us all healthy, a technology solution set is needed that is all-encompassing and that comes second nature to the end user. The true challenge in healthcare is to implement a practical solution that comes second nature to us in life’s daily workflow.

Several studies in healthcare show that most consumers want to use digital services for healthcare regardless of age, thanks to the success of Facebook and other social media platforms. The demand for mobile healthcare is definitely there and is resonating throughout all age groups. Consumers also state that they do not want bells and whistles, but the simple brick and mortar in the healthcare technologies to service their basic needs (supporting efficiency and accuracy). Reinforcing the phrase, “Going big is not always better.”

Given the leveling off of healthcare technology spending, the industry needs to better listen to the healthcare consumer’s wish and bring us back to the basics. Our society is not short of technology solutions, but the healthcare consumer is realizing that for health sustainability, sometimes the reliability and usability of a product might now be worth the effort to keep it.

Providing solutions that will allow self-diagnosis and self reflection are the first steps in acknowledging illness, thereafter empowering steps of going to a clinician for an unbiased assessment.

Helen Figge, PharmD, MBA is senior vice president of LumiraDx of Waltham, MA.

Readers Write: Why Secure Messaging is Failing Hospitals

Why Secure Messaging is Failing Hospitals
By Ben Moore

Healthcare communications are growing up. Where we were once reliant on interruptive, one-way message pushes; device juggling; and kludgy workflows driven by pager use, modern clinicians have a wealth of tools at their disposal to facilitate effective care coordination.

Yet despite a relatively crowded marketplace (some estimates put the number of secure healthcare messaging providers at over 70) and a market that is ripe for disruption (just ask anyone who still uses a pager if they enjoy it), healthcare messaging solutions still face relatively low adoption, with an estimated 85 percent of hospitals still eschewing smartphones in favor of pagers.

Secure messaging and pagers share a common thread. Neither was specifically designed to address the nuances of healthcare communications. They were mass-market solutions that were adopted by healthcare owing to being in the right place place at the right time.

For pagers, adoption was spurred by the need to deliver around-the-clock care while also allowing providers to (occasionally) leave the hospital. For secure messaging solutions, it was a matter of encrypting PHI that clinicians were transmitting from unsecured personal smartphones, mitigating the risk that came with smartphone use in a clinical setting.

As smartphone use grew organically in healthcare workplaces, HIPAA pitfalls abounded:

• Data remained resident on personal (and often unprotected) devices.
• There was little control or policy enforcement.
• There was no guarantee of SMS message receipt.
• There was no visibility at an organizational level that any communication had occurred at all.
• Clinicians became accustomed to utilizing shorthand codes or acronyms to communicate, increasing the propensity for error.

The end result of this was an enormous financial risk of HIPAA violation and compromised care delivery and confusion in the healthcare setting. Secure messaging vendors sought to correct these problems by handling data through a single vendor, implementing message self-destruction from personal devices, guaranteeing message delivery, supporting rich media such as images and video, and performing integrated directory lookup.

If security is the only concern (and don’t get me wrong—it should be a very big concern), these solutions fit the bill. But if the 85 percent of hospitals still utilizing pagers are any indication, healthcare providers are looking for much more when it comes to enabling mobile communications.

In application beyond HIPAA compliance, secure messaging is falling short in a big way. According to a survey conducted this year, 56 percent of providers felt a lack of useful integrations with other software was the leading reason current providers fell short; 44 percent felt they lacked structure and policy; and 33 percent felt that low user adoption was the biggest hindrance.

Inclusion and integrations must be addressed by secure texting apps. Messages are data in its rawest form. If this information is siloed from other departments (for example, if nurses and physicians use different mediums) or different systems (such as scheduling, EMR, nurse call, and paging systems), it’s useless.

The Joint Commission ruling on secure texting states that mobile order entry is not permitted because basic secure messaging lacks the ability to verify the identity of the sender and record a copy of the original message against the EMR. Integrations with Active Directory and EMR software (in that order) ensure that mobile orders remain compliant. Ask any physician if they’re looking for another way be awakened at 4 a.m. when they’re not on call and you may begin to understand why they’re not falling over themselves to try something new (see “adoption issues.”) This can be easily mitigated by integrating with the on-call schedule to ensure that messages and notifications are automatically routed to the correct on-call party.

In the age of big data and informed decisions – and, we’re told, interoperability — there is no excuse for messaging applications to not pull and push relevant or necessary information from other systems to provide additional context, value, and insight.

Healthcare communications are, by and large, structure- and policy-based. Providers in a clinical setting are familiar with not only which information needs to be captured, but who that information needs to be relayed to and when. Basic messaging such as SMS or chat does absolutely nothing to address this (just look at a millennial’s messaging history to confirm.)

For a healthcare communications application to succeed, it must be able to ensure that the relevant information is being captured, and then navigate a complex web of individual providers, care teams, departments, and schedules to deliver that information to the appropriate individuals. Further, secure communication solutions must provide an automated escalation policy and user confirmation of receipt of critical labs to ensure those results are delivered in a timely manner, according to JCAHO’s National Patient Safety Goals.

To address this, next-generation healthcare messaging solutions are building fail-safes into the software itself, including continuous multi-channel delivery attempts (by text and phone), automated escalation rules and message routing in the event that a recipient is unavailable, and delivery visibility so that senders can conclusively confirm a message has been received.

Lastly, in the world of healthcare technology, particularly communication applications, a product is only as good as the number of people who use it. It’s no surprise that a number of secure messaging implementations have been scrapped or cancelled in the face of low adoption. Concerns about device number privacy, a lack of time to learn a new product, or even, yes, pager attachment (a digital version of Stockholm Syndrome) can prevent secure messaging solutions from being successfully rolled out enterprise-wide.

To overcome these obstacles, solution providers must support dedicated number provisioning (providing a unique phone number that exclusively works for communications within the app), pager network integration and pager functionality via a smartphone app (for the pager holdouts), and driving messaging through integration points (some hospitals use as many as 10 disparate systems, including call centers, scheduling solutions, and so on) and providing a user experience that is, at minimum, better than native SMS functionality on smartphones. Really, it’s not that difficult to do.

As a whole, secure healthcare messaging has a lot of room for improvement. However, with the willingness to listen to customers and the ambition to look beyond simply providing security as a service, the opportunity to transform how healthcare workers communicate, collaborate, and deliver care is there.

Ben Moore is founder and CEO of TelmedIQ of Seattle, WA.

How Providers Are Addressing Ransomware

Providers share their methods for staying one step ahead of healthcare’s latest foe.
By @JennHIStalk

While national headlines related to ransomware attacks on hospitals seem to have abated – for now – the healthcare industry’s interest in the latest cyberattack trend has only intensified. Research related to provider preparedness seems to come out weekly, highlighting what has by now become common knowledge: healthcare has a lot of work to do.

A HIMSS study released in early April found that 75 percent of surveyed hospitals were or could have been hit with a ransomware attack in the last year, with a significant number or respondents saying they aren’t sure or have no way to tell. Statistics like these make IBM’s data on industry-wide breaches in 2015 that much more believable, where the global company’s Cyber Security Intelligence Index found that healthcare was the most-attacked industry in 2015 with over 100 million patient records compromised.

The industry is working to handle what seems like a non-stop assault. HHS has created a Cyber Security Task Force to develop recommendations and best practices that could eventually impact legislation. Intermountain Healthcare (UT) has partnered with the University of Utah to establish a joint security center to help providers keep up with the latest cybersecurity threats, while providers in the trenches seem focused more than ever on assessing their cybersecurity vulnerabilities.

Taking a Proactive Approach

Northwell Health, a New York-based IDN with 21 hospitals and 450 ambulatory sites, has taken a proactive approach to cybersecurity, according to Mark Jarrett, MD, senior vice president, chief quality officer, and associate CMO. (Jarrett also serves on the new HHS task force.) “Recent events have only supported our enterprise-wide efforts to secure our network,” he explains. “We are performing hazard vulnerability assessments on a regular basis. As news becomes public of new events, we adapt our defenses. Maintaining all current security patches on our multiple systems is also key. To prevent ransomware attacks, we are employing all standard intrusion techniques from technical, such as firewalls, to staff education and testing so that they understand social phishing and the risks of non-certified thumb drives. We remain concerned as the sophistication of intruders to introduce malware has been increasing.”

Across the country, Texas Health Resources, a health system with 25 hospitals and 69 outpatient facilities serving the Dallas-Fort Worth area, has taken a similar approach. “In the last couple of years, we started to take aggressive action to defend against threats such as ransomware,” says Luis Saldana, MD, CMIO and medical director for clinical decision support. “This action included targeted reduction of direct user access to certain forms of unstructured data such as DICOM images and PDF files. We also have a robust anti-phishing program to reduce the possibilities of a user receiving or being lured into clicking on potentially malicious email links. We’ve also validated our backup and restoration strategies and have fine-tuned our incident response when we detect a ransomware attack.”

In terms of keeping up with emerging security threats, Saldana adds that Texas Health’s cybersecurity program is designed to continuously evolve and adapt. “We do this through a continuous risk-management philosophy that is linked to operations.”

Size Matters

Northwell and Texas Health are capable of taking such proactive approaches thanks to their internal resources – a luxury that smaller hospitals and physician practices are not typically afforded. “I believe small- to medium-sized health systems of stand-alone hospitals and practices that hadn’t had the opportunity to invest in a robust infrastructure to defend against this kind of threat, or that are unable to attract cybersecurity professional talent might be more vulnerable to the impact of such an attack,” says Saldana. “We are fortunate to have a fairly sophisticated cybersecurity program.”

Jarrett points out that with greater resources comes greater vulnerabilities. “Although our size allows us to have more resources than a small hospital or group of hospitals, it also means that there are many more potential sites for failure of our defenses,” he explains. “With 61,000 employees, the task of maintaining a high level of awareness around social phishing is monumental.”

Culture and Consultants Do, Too

Both Jarrett and Saldana are quick to point out that their organizations see cybersecurity threats like ransomware as more than just a problem for the IT department to solve. “Our organizational culture is really what makes this work,” says Saldana. “Our C-suite is very educated on the issues and very supportive, and the programs have been broad in scope – beyond just IT.”

“The C-suite recognizes this is not just an IT issue,” Jarrett adds. “They have supported IT in its efforts to ensure network security.”

For both organizations, support also comes in the form of outside expertise. Northwell engages third-party consultants to evaluate its cybersecurity and provide an outsider approach to vulnerabilities. Texas Health Resources has multiple partners that perform periodic testing of its internal and external defenses, as well as monitor its cyber defenses. “We have selected these vendors through proof-of-concept testing and self-defined cybersecurity capability needs,” Saldana explains.

Prevention Boils Down to Awareness

Saldana believes that cybersecurity prevention and preparation begins with awareness. “The first step is to acknowledge that you are constantly being targeted by threats,” he explains. “Then, backups, backups, backups. Know your recovery time requirements and build backup restoration capabilities to match those requirements. Ensure you have an effective and tested business continuity plan for scenarios when data might be unavailable.”

Saldana also suggested that providers keep their tools up to date and conduct frequent phishing training and testing to prepare employees. “Have an incident response plan in place and prepare your employees to have a heightened awareness,” he adds. “Carefully manage access and be prepared to respond and practice your plan. And don’t forget to keep up with industry intelligence. It’s important to see and learn from other organizations in many areas and to support other organizations who are targets for these types of threats.”

Learning from Hospital Peers

The Intermountain / University of Utah shared Security Operations Center will play a big part in helping providers share industry intelligence around cybersecurity threats in real time. “It will be an opportunity for partner organizations to share learnings and intellectual property around security,” says Intermountain CIO Marc Probst. “There is also the opportunity to share some technical solutions and security intelligence. For example, the ability to immediately understand threats that other organizations are experiencing and to take action to prevent these at your own organization. To the extent organizations are members of the shared SOC, they could inherit these benefits.”

Probst adds that organizers hope to see the center up and running before the end of this year. “There are many details to work out.” he explains, “It’s possible that the participants could change and/or increase. There’s still a lot of work to do, but we are convinced that this is a good idea and we are actively pursuing it.”

Probst’s words reflect the learning curve the healthcare industry is still experiencing when it comes to cybersecurity and more targeted ransomware attacks. There is still – and will likely always be – a lot of work to do. Culture, collaboration, and vigilance will be key to ensuring that ransomware-related headlines soon become a thing of the past.

Morning Headlines 4/27/16

Nokia Just Made Its First Big Move Into Digital Health

Nokia acquires Withings, a digital health company that markets Bluetooth connected scales, blood pressure cuffs, and other medical devices, for $192 million.

Proposed Sanctions – Conditions Not Met Immediate Jeopardy

CMS publishes the letter it sent to Theranos last month in response to the company’s plan to correct problems found at its California lab, noting that the company’s responses “show a lack of understanding of the CLIA requirements.”

Verisk Analytics, Inc., Signs Definitive Agreement to Sell Its Healthcare Services Business to Veritas Capital for $820 Million

Veritas Capital acquires the health service business of Verisk Analytics for $820 million.

News 4/27/16

Top News

Nokia will acquire France-based consumer digital health device vendor Withings for $192 million to create Nokia Digital Health.

Finland-based Nokia, which sold its mobile phone business to Microsoft in 2013, sells telecommunications infrastructure and licenses its brand name and patents.

Microsoft announced last year that it would write down $7.6 billion on its Nokia phone business (for which it paid only $7.2 billion) and would cut 7,800 related jobs as it refocused on the Windows Phone, sales of which were announced last week to be continuing their steady descent into market share rounding error territory.

Reader Comments

From Day1Date: “Re: NextGen. The ongoing restructuring continues with a layoff of around 5 percent focused on corporate, RCM, and ambulatory. This is to further the goal of focusing the company on being the best PM/EHR vendor in the market.” Several  readers report that NextGen has let 150 people go.

From Femdom: “Re: the HIMSS HIT rag. They’re creating a ‘room of one’s own’ with a separate section of their website and a newsletter for women only. I’m not sure that’s a good idea or even necessary.” That sounds like an awkward, paternalistic grab for feel-good advertising eyeballs to me. I doubt that whatever gender disparity exists in healthcare IT was caused by lack of vapid, gender-specific faux news; retweeted links to generic articles under the guise of “awareness” of which everyone is already amply aware; and running feel-good profiles of women whose accomplishments they devalue in spreading the recognition collectively over all women and not just the achiever. Creating what is in essence a special interest group for any demographic group seems like a step backwards to me no matter how well intentioned. Perhaps the publication could start by launching a hard-hitting investigative report as to why six of the seven executives of its parent organization HIMSS are white males.

Disregarding my own cynicism for a moment, I will defer to HIStalk readers – take my poll as to whether a separate HIMSS-published site and newsletter for women is a good idea. Click the poll’s Comments link after voting to make your case.

HIStalk Announcements and Requests

Mrs. Lee says her Arizona kindergarten students are using the math puzzles and magnetic wands we provided in funding her DonorsChoose grant to further their STEM knowledge.

Here’s a reminder to prevent the appearance of cluelessness: do not refer to times as “EST” since we’re on “EDT” until November 6. I’m surprised at how many seemingly otherwise competent people can’t keep this straight, and additionally surprised at how much it annoys me when they don’t. Under the premise that it’s better to mumble than shout when you aren’t sure, you can simply say “ET” and be correct all year.

Webinars

May 5 (Thursday) 2:00 ET. “Reducing CAUTI and Improving Early Sepsis Detection Through Clinical Process Measurement.” Sponsored by LogicStream. Presenters: Jen Biltoft, director of quality improvement, SCL Health; Marla Bare, EHR architect, SCL Health. This webinar will describe how SCL Health reduced catheter-associated urinary tract infections by 30 percent in just three months through clinical process measurement. The SCL Health presenters will also share their plans for applying a similar process to the early detection of sepsis.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Augmedix, which offers a Google Glass-powered remote scribe service, raises $17 million from five large health systems that include Sutter Health and Dignity Health, increasing its total to $40 million. Google’s development of an enterprise version of Glass – which never graduated from beta status and has largely disappeared even within Google’s hierarchy — has not been announced, leading Augmedix to suggest that it may explore other technologies. The company has a few hundred California doctors using its services.

CMS releases the 45-page warning letter it sent to lab testing vendor Theranos last month, in which it individually addresses the company’s responses to dozens of problems at the California lab of Theranos with, “The laboratory’s allegation of compliance is not credible and evidence of correction is not acceptable.” The letter adds that the company’s responses “show a lack of understanding of the CLIA requirements.” CMS notes that Theranos diluted finger-stick samples so they could be processed on a standard Siemens lab machine, a practice that CEO Elizabeth Holmes had previously denied.

Verisk Analytics will sell its Verisk Health services business to Veritas Capital for $820 million. I ran a rumor of the sale in early October 2015 and the company announced later that month that it was exploring strategic alternatives for the business. Veritas has no other healthcare holdings, but the private equity firm cashed in big in selling the Truven Health Analytics business it bought from Thomson Reuters for $1.25 billion in mid-2012 to IBM, which paid $2.6 billion to acquire the company in February 2016.

Medical communications transaction platform vendor MEA-NEA-TWSG renames itself Vyne. Its newly created Vyne Medical business unit includes the former Medical Electronic Attachment (claims attachments) and The White Stone Group (healthcare communications management), while its National Electronic Attachment business unit offers electronic attachment management for dental practices.

Blockchain technology vendor Gem launches Gem Health, which is partnering with Philips to build a healthcare blockchain ecosystem.

Roper Technologies – whose healthcare IT holdings include Sunquest and Strata Decision – reports Q1 results: revenue up 4 percent, EPS $1.48 vs. $1.54, missing expectations for revenue and non-adjusted earnings but beating on adjusted earnings. CEO Brian Jellison said in the earnings call that Strata’s growth is “really exceptional” and that Roper will make more acquisitions.

Patient payments and check-in software vendor Inbox Health acquires the consumer health expense management technology of CakeHealth, which seems to have accomplished little beyond spending its tiny 2011 funding ($150K) despite aspirations of becoming “the Mint for healthcare.”

Apple reports Q2 results: revenue down 13 percent, EPS $1.90 vs. $2.33, missing expectations for both and guiding down as the company records its first revenue decline since 2003. It was also the first quarter in which iPhone sales dropped as Apple produced little innovation beyond offering bigger iPhone screens. AAPL shares dropped sharply in after-hours trading following the announcement. They’re down 20 percent in the past year.

Also turning in crappy quarterly numbers is Twitter, shares of which are tanking in after-hours trading Tuesday as the company misses revenue and earnings expectations wildly and reports slowing user growth despite its desperation-smelling rollout of Periscope and Moments.

Sales

Baylor Scott & White Health (TX) will implement the Pieces surveillance and population health management system and will make an unspecified investment in the company. Pieces raised a $21.6 million Series A round last month.

People

Switzerland-based healthcare wireless and security technology vendor Ascom names Holger Cordes (Cerner) as CEO.

John Driscoll (Care Centrix) and John Glaser (Cerner) join the board of Press Ganey.

Announcements and Implementations

InterSystems will interface its TrakCare information system to the blood ordering and inventory management system of the Australian National Blood Authority to allow its users to automate blood ordering and distribution.

CareOne LTAC Hospitals (NJ) completes its implementation of NTT Data’s Optimum Clinicals.

Government and Politics

India passes a law requiring cell phone manufacturers to add a panic button and satellite-based locating technology to their smartphones, hoping to improve the country’s widely publicized rape problem. India doesn’t have a 911-type emergency number but hopes to introduce one soon. Companies sell several personal safety apps (such as My Safetipin, above) to India-based customers, most of which notify an emergency contact and share the user’s location.

In Australia, the state of Victoria will spend $23 million to develop a real-time database to help doctors and pharmacies identify patients who overuse prescription drugs. Victoria recorded 330 deaths from prescription drug overdoses last year, more than the number of people killed in car accidents or from overdoses of illegal drugs.

Parents of children with muscular dystrophy testify to the FDA about the benefits their children receive from taking a drug with questionable proven effectiveness. Afterward, the FDA declared that the drug company’s poorly designed, 12-patient study was not sufficient to prove the drug’s value, but three of the 10 panel members abstained from voting after being moved by the comments of the parents. Following the “no” vote, some of the audience members shouted at the advisory panel. The FDA says it will “take the views of the community into account.” I can’t decide if that’s an admirable move toward patient empowerment that shows the value of “little data” or an uncomfortable vaccine-like abandonment of science in allowing laypeople to argue with emotion rather than documented facts.

The FDA warns drug companies that it won’t accept clinical studies that use data prepared by India-based Semler Research Center after an FDA inspection turns up evidence of intentional data tampering.

New York Mayor Bill de Blasio will propose big changes and $2 billion in subsidies to bail out money-hemorrhaging NYC Health + Hospitals that include reducing ED visits, turning inpatient space into ambulatory facilities, and developing vacant property, all while closing no facilities or laying off any employees to avoid $6 billion in losses over the next five years. The consultant’s report is here.

Innovation and Research

A study of the 46,000 Maryland residents who had a least five ED visits in 2014 finds that 70 percent of them used more than one hospital, meaning that most hospitals won’t be able to identify those high ED users or coordinate their care using their own data alone.

Other

An op-ed article in a British newspaper says idealistic young Americans should work on domestic problems instead of trying to save the world in addressing overly simplified issues in exotic locations. It explains the “reductive seduction of other people’s problems” as being no different than if an idealistic, naive student in Uganda traveled to America for the first time, confidently expecting to win fame and maybe an award for fixing our gun violence problem. In a related item, a new book questions whether healthcare volunteers who trek off to developing countries for short stints help or hurt those communities, with the author concluding after analyzing the available data that the net effect is probably slightly positive if the volunteer has the right attitude. The problems with medical volunteers include that they may be tempted to perform tasks that exceed their skill level, they may try to impose unrealistic US standards,  and that they could hurt local doctors by undermining confidence or offering free services that put them out of business.

Western Australia’s health department, which hasn’t had a permanent CIO since 2010, gives up after finding no suitable candidates and instead creates a support services organization led by a procurement specialist who will oversee IT. WA Health’s troubled IT implementation delayed the opening of newly built 783-bed Fiona Stanley Hospital in 2013.

Sponsor Updates

• AirStrip announces that 4 million US births have been monitored using its system over the past 10 years.
• Interactive patient TV vendor PDi will provide patient education videos from Elsevier.
• Aprima will exhibit at the American College of Physicians Internal Medicine Meeting May 5-7 in Washington, DC.
• Audacious Inquiry’s Team Ai took first and second place at the Port to Fort 6k.
• Team EcoBase from First Databank and Zynx Health wins second place at the FHIR Connectathon in Indianapolis.
• Besler Consulting releases a new podcast, “Comprehensive Care for Joint Replacement (CJR) Target Pricing & Episode Spending Calculations.”
• CenterX will exhibit at the NCPDP May Work Group Meetings May 1-2 in Scottsdale, AZ.
• Obix posts a video covering the use of its perinatal data system at Norman Regional Hospital (OK).
• CitiusTech will exhibit at the LHC Executive Briefing with Milton Johnson, chairman and CEO, HCA, May 4 in Nashville.
• Crossings Healthcare Solutions releases its Spring 2016 e-letter.
• Direct Consulting Associates will exhibit at iHealth 2016 May 5-6 in Minneapolis.
• EClinicalWorks will exhibit at the American College of Physicians Internal Medicine Meeting May 5-7 in Washington, DC.
• Extension Healthcare will exhibit at the IONL Mid-Year Conference April 29 in Bloomington-Normal, IL.
• HCS will exhibit at the NALTH 2016 Spring Clinical Education & Annual Meeting April 28-29 in Memphis, TN.
• Healthwise will exhibit at the ZeOmega Client Conference May 2-4 in Plano, TX.

Blog posts

• Solving Notification Overload in Healthcare (TelmedIQ)
• Raise Your Patient Satisfaction Scores, 2 Planning Tips (Part 1 of 2) (AdvancedMD)
• Adapting to the New Wave of Nursing (AirStrip)
• Why Your Business’ Mobile App Strategy will Probably Fail (If It Hasn’t Already) (AirWatch)
• What in the Health IT is a Hierarchical Condition Category (HCC)? (Arcadia Healthcare Solutions)
• Filling Your Prescription for Desktop Security: 7 Levels of Access Management (Aventura)
• 4 Essentials to Establishing Clinical Integration (Catalyze)
• The Future of Enterprise Mobility is Here: What’s your strategy? (PatientSafe Solutions)
• Nine Notes from NAACOS16 (Caradigm)
• Things to Consider Before Starting a CCM Program: Requirements, Compliance, Buying vs. Building, and Integration (Caresync)
• Florida Joins Legislative Movement Toward Uniformity in Prior Authorization (CoverMyMeds)
• 50 Years and Counting (CTG)
• Placing a Premium on AMC Performance (ECG Management Consultants)
• Securing Your Practice (E-MDs)
• Maximizing Your Conversion Through Assessment (Galen Healthcare Solutions)
• Caring for the Clinician: The Key to Improving Patient Experience, Enhancing Health Outcomes, and Reducing Cost (Hayes Management Consulting)
• Epic Upgrade: Single vs. Double Upgrade (The HCI Group)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates.
Send news or rumors.
Contact us.

Morning Headlines 4/26/16

What We Mean When We Talk About EvGen Part I: Laying the Foundation for a National System for Evidence Generation

In a blog post, FDA Commissioner Robert Califf, MD calls for greater interoperability and connectivity in healthcare IT in order to help researchers create a national system for evidence generation.

Customizing transitional care for N.C. Medicaid patients

Community Care of North Carolina, which coordinates care for 1.4 million Medicaid beneficiaries in the state, has developed an algorithm-based population health program that has significantly reduced hospitalizations and readmissions for patients with multiple chronic medical conditions.

Augmedix nabs $17M to ‘rehumanize’ doctor/patient relations using Google Glass

Google Glass startup Augmedix raises a $17 million investment round from Catholic Health Initiatives, Dignity Health, Sutter Health, TriHealth Inc., and a fifth anonymous investor. Augmedix is building an app that allows scribes to remotely monitor patient encounters, documenting the visit note and navigating the EHR on behalf of the provider.

Medicare’s New Physician Payment System

Health Affairs discusses the new physician payment system put in place with the passage of MACRA.

Curbside Consult with Dr. Jayne 4/25/16

I wrote last week about my experience with a client who had been swindled by a practice administrator who had promised far more than he could deliver. A reader commented: “I would have loved to hear a few more specifics on what a practice might do to avoid hiring such an administrator or office manager. It has also been my experience that too many independent practices don’t seem to know what to really look for and consequently suffer down the road.”

I’ve certainly done more than my share of hiring and firing over the last decade. On my own, I’ve employed medical assistants, office managers, and partners. I also had to terminate at least one of each. As part of the corporate world, I’ve had to deal with vetting a host of positions including clinical staff, IT staff, managers, and operations execs. As a consultant, I’ve been asked to deal with errant members of the C-suite and upper management and also to assist in finding their replacements.

The best tip I can offer anyone in a hiring position is an old adage: trust your gut. Nearly every time I’ve gone against my gut, there’s been a poor outcome. Sometimes you can’t avoid it, especially if you’re in an employed capacity or part of a larger corporate entity.

For example, I once had to hire an analyst to run some lab interface work. The health system’s HR department (which usually left something to be desired) was only able to find two candidates who were remotely qualified. Although their resumes were decent, both of them interviewed somewhat poorly. I felt the first one didn’t understand the job we were offering, despite our attempts to explain it and talk about the work she would be doing. She kept going back to what she had done in the past and how good she was at it, even though we were trying to assess whether she’d be a good fit going forward.

The second one was too folksy right off the bat. Don’t get me wrong, I’m a folksy girl myself, but there’s a time and place for familiarity and it’s not in a job interview. I don’t want to hear about your children and your weekend plans – not because I don’t care, but because it’s too easy to get close to discussion topics that are normally a bad idea during the interview process. She seemed to be much more eager than the other candidate, but I didn’t really feel that she would be able to get the job done.

I wanted to go back to HR and ask them to look for other candidates, but was under pressure to fill the open posting immediately to ensure we could get someone in the position before a series of budget cuts that might force us to pull the opening off the board.

Although her interface skills were decent, it turned out that her overly casual demeanor was reflective of casual regard which she paid to all her work. When asked for status reports, it always felt like she was on the cusp of getting to the tasks that needed to be done, rather than actually doing them. She also liked to spend a lot of time chatting with other team members, which impacted not only her productivity, but that of others. It felt like she spent a lot of time doing nothing and then sprinted towards the deadline, which was a poor fit for our company culture.

Although I was involved in the hiring, I wasn’t her direct manager. He didn’t seem to have the wherewithal to deal with her because she interpreted every element of constructive criticism as “being mean.” Needless to say, she didn’t last very long. My failure to fight for my gut feeling in that situation bothered me for a long time.

Besides following your instinct, it’s important to watch out for people that seem too good to be true. Maybe they have a seemingly stellar record of accomplishments, but are willing to work for a salary that is lower than they appear to be worth. Sometimes you can get a bargain, but usually there’s a good story to go along with it. For example, a highly-skilled administrator who moves to a small town to care for aging parents or someone who needs a more low-key role to provide greater work-life balance. Usually these candidates realize that they may seem oddly matched for a position and will take the lead on explaining their desire to move down the ladder.

Other times, though, they might not have a good explanation for why they left their last position, or the references they provide don’t seem to make sense. I admit that it’s getting harder and harder to get a decent reference, particularly from past employers. Often organizations will simple verify the dates that the individual was employed. If you’re lucky, they might tell you if the person is eligible for rehire. Getting a true reference that you feel you can trust is like gold.

Other things that I sometimes don’t see smaller practices do: the consumer background check. They may do a criminal check, but not a consumer one. In this day and age, it’s important to know whether the people you are hiring have had any financial difficulties, particularly if they are going to be a position to handle funds within the office. Of course, that won’t tell you if the employee will make bad decisions, like the front desk staffer that I fired after finding $1,200 in co-pays in the sample closet. Why, you might ask, was the money in the sample closet? Because she didn’t have time to go to the bank and do the deposit each night, so she wanted to keep it somewhere “safe.”

Organizations should also make sure that candidates have valid experience for the position they’re trying to fill. Candidates might not have held the exact same job or title, but should be able to clearly explain how their previous experience will translate to the new position. Especially for higher-level roles, most organizations don’t have time to deal with someone who cannot hit the ground running. I do occasionally see it though, with groups that feel like they can mold someone into something that they may not be able to become.

Administrators should be able to talk about their achievements in previous roles and cite metrics for practices they’ve led. How have their days in accounts receivable been? Even if they weren’t stellar, did they show a positive trend? What initiatives did the candidate lead to try to move things in the right direction?

Potential employers need to have a list of solid questions to ask that relate to the needs of the organization. If you’re planning to become a Patient-Centered Medical Home, ask about that experience. If the candidate doesn’t have experience, ask him/her what he/she would do to get up to speed should they be hired. Anyone worth their salt should be able to articulate a plan to learn about a new discipline or new initiative, especially since the healthcare system we may be operating in over the next few years doesn’t exist yet. If they can’t come up with a reasonable strategy, they might not be a good fit.

Once an administrator or practice manager is hired, the practice should keep close tabs on their performance, not only in the initial hiring period, but in a regular ongoing fashion. Practice leadership (owners, partners, managers, etc.) should be having monthly meetings to review financials and potential problem areas in the practice. If the administrator says everything is rosy all the time, something is wrong. Even in the strongest practices there is always opportunity for improvement or some sort of personnel issue to make management aware of.

Owners or top leadership should also watch out for staffers that continuously spread blame around to vendors, payers, or other staff without showing even the smallest level of introspection about whether they could have done something differently.

Another good question to help assess a potential hire is this: “Given what you know about our organization, if you are hired into this position, what do you see the first six months looking like?” In my experience, candidates who plan to do a good amount of listening and observing before making too many changes are often the best. They’re willing to take their time to figure out what they have to work with, assess the team’s strengths and weaknesses, and make a careful plan rather than coming in with guns blazing.

What’s your worst hiring or firing nightmare? Email me.

Email Dr. Jayne.